How to pay for premiums is key issue

WASHINGTON — Congressional Democrats and President Barack Obama began work in earnest Tuesday on difficult issues still standing in the way of their national health care overhaul after months of tortuous debate. Topping the list: How to help Americans pay for insurance premiums.

At a White House meeting that stretched into Tuesday evening, the president and Democratic congressional leaders agreed on fast-track negotiations that would bypass the need for a formal conference to resolve differences between the House and Senate health care bills.

Obama "also stated his intention to work with leaders to strengthen affordability ... beyond what is in the Senate bill," said a House leadership aide, who spoke on condition of anonymity because the meeting was private.

The president met with House Speaker Nancy Pelosi, D-Calif., and House Majority Leader Steny Hoyer, D-Md. Joining the discussion by telephone were Senate Majority Leader Harry Reid, D-Nev., and Sen. Dick Durbin, D-Ill., who were out of town.

House Democratic leaders will head back to the White House this afternoon. Staffers from the House and Senate will meet with administration aides this week to formally begin sorting through issues — with the White House taking a lead role in settling disputes.

Republicans aren't invited, and they complained that the Democrats intended to deliberate behind closed doors — though lawmakers often do so in the final stages of such complex legislation. Separately, the head of C-SPAN, the nonpartisan public affairs network, called for letting the sun shine in on the discussions — as Obama once had promised.

House Democrats face the virtual certainty that they will not get the government-run insurance plan liberals had sought, a point Pelosi acknowledged after meeting earlier in the day with key committee leaders.

"There are other ways to do that, and we look forward to having those discussions," she told reporters.

Obama wants to sign sweeping legislation to extend insurance coverage by the time of his State of the Union speech, expected in early February. Separate bills passed by the House and Senate would require nearly all Americans to get coverage and would provide subsidies for many who can't afford the cost — but they differ on hundreds of details. Pressure to get a final bill means Democratic congressional leaders are likely to bypass formal negotiations as they reach for a deal.

In exchange for losing the federal "government option," House Democrats are pressing the Senate to make premiums more affordable for Americans. The outcome of the talks could mean savings of hundreds of dollars for families buying coverage through new insurance supermarkets created by the legislation.

Pelosi said she wants the final product "to ensure affordability for the middle class, accountability for the insurance companies, (and) accessibility by lowering costs at every stage."